Fillable Conservation Area Consent App Form (Mid Devon District Council)

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Conservation Area Consent App Form (Mid Devon District Council)

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$Date:: 2015-04-02 #$ $Revision: 6149 $
Application for planning permission for relevant demolition in a conservation area.
Town and Country Planning Act 1990
You can complete and submit this form electronically via the Planning Portal by visiting www.planningportal.gov.uk/apply
Publication of applications on planning authority websites
Please note that the information provided on this application form and in supporting documents may be published on the
Authority’s website. If you require any further clarification, please contact the Authority’s planning department.
Please complete using block capitals and black ink.
It is important that you read the accompanying guidance notes as incorrect completion will delay the processing of your application.
1. Applicant Name and Address
Title: First name:
Last name:
Address 1:
Address 2:
Town:
Address 3:
County:
Country:
Postcode:
Company
(optional):
House
number:
House
name:
House
suffix:
Unit:
2. Agent Name and Address
Title:
House
name:
House
suffix:
House
number:
Unit:
Company
(optional):
First name:
Last name:
Address 1:
Address 2:
Town:
Address 3:
County:
Country:
Postcode:
3. Description of the Proposal
Please describe the proposed works:
$Date:: 2015-04-02 #$ $Revision: 6149 $
4. Site Address Details
Please provide the full postal address of the application site.
House
name:
House
suffix:
House
number:
Unit:
Address 1:
Address 2:
Town:
Address 3:
County:
Postcode
(optional):
Easting: Northing:
Description of location or a grid reference.
(must be completed if postcode is not known):
Description:
3. Description of the Proposal (continued)
Has the work already started?
NoYes
If Yes, please state the date when the work
was started (DD/MM /YYYY):
(date must be pre-application submission)
Has the work been completed?
NoYes
If Yes, please state the date when the work
was completed (DD/MM /YYYY):
(date must be pre-application submission)
5. Related Proposals
Are there any current applications, previous
proposals or demolitions for the site?
NoYes
If Yes please describe and include the planning application
reference number(s), if known:
Description
Reference
number
6. Pre-application Advice
Has assistance or prior advice been sought from the local
authority about this application?
NoYes
If Yes, please complete the following information about the advice
you were given. (This will help the authority to deal with this
application more efficiently).
Please tick if the full contact details are not
known, and then complete as much as possible:
Officer name:
Reference:
Date (DD/MM /YYYY):
(must be pre-application submission)
Details of pre-application advice received?
Have you consulted your neighbours or
the local community about the proposal?
Yes No
If Yes, please provide details:
7. Neighbour and Community Consultation
9. Explanation for Proposed Demolition Work
Why is it necessary to demolish all or part of the building(s) and/or structure(s)?
8. Authority Employee / Member
With respect to the Authority, I am:
(a) a member of staff
(b) an elected member
(c) related to a member of staff
(d) related to an elected member
Yes No
If Yes, please provide details of the name, relationship and role
Do any of these
statements apply to you?
$Date:: 2015-04-02 #$ $Revision: 6149 $
10. Ownership Certificates and Agricultural Land Declaration
One Certificate A, B, C, or D, must be completed with this application form
CERTIFICATE OF OWNERSHIP - CERTIFICATE A
Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14
I certify/The applicant certifies that on the day 21 days before the date of this application nobody except myself/ the applicant was the
owner* of any part of the land or building to which the application relates, and that none of the land to which the application relates is, or
is part of, an agricultural holding**
NOTE: You should sign Certificate B, C or D, as appropriate, if you are the sole owner of the land or building to which the
application relates but the land is, or is part of, an agricultural holding.
* “owner” is a person with a freehold interest or leasehold interest with at least 7 years left to run.
** “agricultural holding” has the meaning given by reference to the definition of “agricultural tenant” in section 65(8) of the Act.
Signed - Applicant: Or signed - Agent: Date (DD/MM/YYYY):
CERTIFICATE OF OWNERSHIP - CERTIFICATE B
Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14
I certify/ The applicant certifies that I have/the applicant has given the requisite notice to everyone else (as listed below) who, on the day
21 days before the date of this application, was the owner* and/or agricultural tenant** of any part of the land or building to which this
application relates.
* “owner” is a person with a freehold interest or leasehold interest with at least 7 years left to run.
** “agricultural tenant” has the meaning given in section 65(8) of the Town and Country Planning Act 1990
Name of Owner / Agricultural Tenant
Address
Date Notice Served
Signed - Applicant: Or signed - Agent: Date (DD/MM/YYYY):
$Date:: 2015-04-02 #$ $Revision: 6149 $
10. Ownership Certificates and Agricultural Land Declaration (continued)
CERTIFICATE OF OWNERSHIP - CERTIFICATE C
Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14
I certify/ The applicant certifies that:
• Neither Certificate A or B can be issued for this application
• All reasonable steps have been taken to find out the names and addresses of the other owners* and/or agricultural tenants** of
the land or building, or of a part of it, but I have/ the applicant has been unable to do so.
* “owner” is a person with a freehold interest or leasehold interest with at least 7 years left to run.
** “agricultural tenant” has the meaning given in section 65(8) of the Town and Country Planning Act 1990
The steps taken were:
Name of Owner / Agricultural Tenant
Address
Date Notice Served
Notice of the application has been published in the following newspaper
(circulating in the area where the land is situated):
On the following date (which must not be earlier
than 21 days before the date of the application):
Or signed - Agent:Signed - Applicant: Date (DD/MM/YYYY):
CERTIFICATE OF OWNERSHIP - CERTIFICATE D
Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14
I certify/ The applicant certifies that:
• Certificate A cannot be issued for this application
• All reasonable steps have been taken to find out the names and addresses of everyone else who, on the day 21 days before the
date of this application, was the owner* and/or agricultural tenant** of any part of the land to which this application relates, but I
have/ the applicant has been unable to do so.
* “owner” is a person with a freehold interest or leasehold interest with at least 7 years left to run.
** “agricultural tenant” has the meaning given in section 65(8) of the Town and Country Planning Act 1990
Signed - Applicant: Or signed - Agent: Date (DD/MM/YYYY):
The steps taken were:
On the following date (which must not be earlier
than 21 days before the date of the application):
Notice of the application has been published in the following newspaper
(circulating in the area where the land is situated):
11. Planning Application Requirements - Checklist
Please read the following checklist to make sure you have sent all the information in support of your proposal. Failure to submit all
information required will result in your application being deemed invalid. It will not be considered valid until all information required by
the Local Planning Authority has been submitted.
The original and 3 copies of a completed and dated
application form:
The original and 3 copies of a plan which identifies the
land to which the application relates and drawn to an
identified scale and showing the direction of North:
The original and 3 copies of other plans and
drawings or information necessary to describe
the subject of the application:
The original and 3 copies of the completed, dated Ownership
Certificate (A, B, C, or D – as applicable) and Article 14
Certificate (Agricultural Holdings):
$Date:: 2015-04-02 #$ $Revision: 6149 $
Or signed - Agent:Signed - Applicant: Date (DD/MM/YYYY):
(date cannot be
pre-application)
12. Declaration
I/we hereby apply for planning permission/consent as described in this form and the accompanying plans/drawings and additional
information. I/we confirm that, to the best of my/our knowledge, any facts stated are true and accurate and any opinions given are the
genuine opinions of the person(s) giving them.
13. Applicant Contact Details
Telephone numbers
Country code:
National number:
Extension
number:
Country code:
Mobile number (optional):
Country code:
Fax number (optional):
Email address (optional):
14. Agent Contact Details
Telephone numbers
Country code:
National number:
Extension
number:
Country code:
Mobile number (optional):
Country code:
Fax number (optional):
Email address (optional):
15. Site Visit
Can the site be seen from a public road, public footpath, bridleway or other public land?
NoYes
If the planning authority needs to make an appointment to carry
out a site visit, whom should they contact? (Please select only one)
Other (if different from the
agent/applicant's details)
ApplicantAgent
If Other has been selected, please provide:
Contact name: Telephone number:
Email address:
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Conservation Area Consent App Form (Mid Devon District Council)

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Completed 23 July 2020

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